The Framingham risk score (FRS)
- Framingham Cardiac Risk Score Calculator
- Framingham Risk Score Calculator Cdc
- Framingham Risk Score Calculator Pdf To Excel Converter
- Framingham Risk Calculator Pda
- Framingham Risk Score Calculator Pdf To Excel Format
- For more information about the inputs and calculations used in this app, see “Terms and Concepts” in the Resources tab below. 10-year risk for ASCVD is categorized as: Low-risk (risk (5% to 7.4%) Intermediate risk (7.5% to 19.9%) High risk (≥20%) Indicates a field required to calculate current 10-year ASCVD risk for patients age 40-79.
- It was developed by the Framingham Heart Study to assess the hard coronary heart disease outcome. It is used to estimate the risk of heart attacks in adults older than 20. In the below calculator enter your gender, age, cholestrol level, BP and you get the 'Framingham Risk Score' and the risk of developing CHD.
- American (National Cholesterol Education Program) and European guidelines uses the FRS to classify people for primary prevention. Those with score <10% are classified as low risk, 10-20% as moderately high risk and >20% as high risk.
- People with established CVD (cardiovascular disease) or diabetes are already at high risk of CVD events and are targeted for maximum aggressive therapy with an LDL goal of <100 mg/dl, with an optional goal of LDL<70 mg/dl in very high risk patients.1 Those who have high triglycerides should also meet the non-HDL-C goal which is set at 30 mg/dl higher than the LDL goal.
Appendix B: Framingham 10-year Risk Estimation Step 1: Calculate the patient’s total points using Table 1. Step 2: Determine the patient’s 10-year CVD risk using Table 2. Double risk percentage if there is a history of premature CVD (men.
Framingham Cardiac Risk Score Calculator
- The FRS is derived from the landmark Framingham Heart Study (FHS) that has provided valuable insights into CAD (coronary artery disease) risk prediction. The FRSis based on the clinical experience and coronary events of 5,209 men and women (aged 28-62 years) followed since 1948 and have guided the delivery of preventive cardiology for half a century.2
- Launched in 1948, blood pressure readings for each subject were taken at two year intervals for a period of 14 years and the findings dispelled several myths that existed then and shared by some even today.3One such myth was “ The greatest danger to a man with blood pressure lies in its discovery because some fool may try to treat it.”4The first key finding from the study was that both systolic blood pressure (SBP) and diastolic blood pressure (DBP) are key markers of cardiovascular risk, especially stroke, heart failure, and heart attacks.3
- Weighted scores are assigned to 6 easily measurable constructs─ total cholesterol (TC), HDL-C, systolic blood pressure, treatment of hypertension, smoking status, age and gender.5
Table125A. Differences in Estimated 10year CAD risk among White, Asian Indian and Chinese based on Framingham Risk Score5-7 | ||||||
Risk Factors | Whitemale | White female | Indianmale | Indianfemale | Chinese male | Chinesefemale |
Age -50yrsTotal cholesterol-225mg/dl HDL-35mg/dl Blood Pressure – 130/80 Smoking- 1 pack/d | 16% | 11% | 32% | 22% | 3% | 2% |
Overestimation and Underestimation of the Risk
- D’Agostino et al 8 applied FRS calculations to 6 prospectively studied, ethnically diverse populations within the US. It was discovered that the FHS performed well for whites and blacks. Among Japanese American and Hispanic men and Native American women, the FRS systematically overestimated the risk. After recalibration, taking into account different prevalence of risk factors and underlying rates of developing CAD, the authors were able to construct more accurate models for those subgroups whose risk was overestimated by the conventional method. 8
- The prediction of absolute risk was not very accurate when a model derived from one study was applied to a different study or population.9 The FRS has been shown to substantially overestimate the risk, when applied to northern Europeans (including UK, Belfast) with high risk of CAD and particularly in southern Europeans with low risk of CAD. 10-13 Over 50% of the variance in CAD death rates in 25 years was accounted for by the difference in mean serum cholesterol.14 The overestimation was as high as 2-fold among Spaniards and 4-fold among Chinese, but the accuracy could be improved by recalibration.12
- The FRS systematically overestimated the absolute CAD risk in the Chinese Multi-provincial Cohort Study (CMCS). This cohort consisted of 30,121 adults aged 35-65 years at baseline and was followed for 12 years. The 10-year CAD rate of the CMCS cohort was one-fifth that of the Framingham cohort.
- For example, in the 10th risk decile, the predicted rate of CAD death in men was 20% CMCS vs. an actual rate of 3%. The proportion of Chinese people with 10-year risk exceeding 10% was 9.9% by FRS estimate but only 0.35 by the CMCS functions. 6 The recalibration of the FRS using the mean values of risk factors and mean CAD incidence rates of the CMCS cohort substantially improved the performance of the FRS functions in the CMCS cohort. 6 Nevertheless, application of recalibrated FRS models again significantly overestimated the CAD risk in both men (by approximately 97%) and women (by approximately 228%).
- Stroke is much more prevalent than CAD in China; thus, any risk prediction model only for CAD may not be appropriate in application. In another study involving 9903 Chinese followed for 17 years, of the 371 CVD events, 266 were ischemic strokes and 105 were coronary events.15
- Recently a simplified point score model has been developed and tested for estimating the 10-year integrated cardiovascular risk (Ischemic stroke and heart attack) in Chinese, in whom stroke is the predominant form of CVD. This model uses age, systolic blood pressure, smoking, total cholesterol, diabetes and BMI (body mass index).15 Since overestimation of the risk in Chinese population could result in over treatment, the Framingham risk function cannot be used without calibration.
- In sharp contrast to the Chinese the FRS underestimate the risk of CAD among Indians by 200%.7 See Underestimation of risk among Asian Indians.
- Recalibrating the Framingham equations to the event rate and the prevalence of the risk among Spaniards and Chinese have been shown to improve the prediction of the risk. After calibration, the FRS function became an effective method of estimating the risk .8 The FRS-based coronary risk chart overestimates absolute coronary risk in populations characterized by a lower incidence of CAD events and should be used with caution.
Limitations of the FRS
- The FRS is recommended only for patients with > 2 risk factors and is not accurate in patients with extreme end of a particular risk factor such as heavy smoking or very high cholesterol level.
- FRS uses TC (instead of LDL-C) and does not include risk factor modification interventions, except for hypertension. It does not include family history or south Asian ethnicity both of which are known to confer 2-fold risk of future CAD 16, 17 It also does not include other identified risk factors such as overall and abdominal obesity, physical inactivity, metabolic syndrome, high lipoprotein(a), high triglycerides, non-HDL-C, apolipoprotein B, C-reactive protein, fibrinogen, left ventricular hypertrophy, estimated glomerular filtration rates etc.
Framingham Risk Score Calculator Cdc
- The FRS includes only CAD events but excludes other vascular events such as stroke, which are more common than heart attack in Asian populations. The scoring was developed by studying a predominantly white and middle class population and particularly useful in the elderly but not be accurate for young and people of other ethnic origin. 18, 19
- The young subjects in FHS were not only underrepresented but had very few events, which led to its heavy emphasis on age and is unsuitable for predicting premature CAD (defined as 55 years and younger in men and 65 years and younger in women). In a study of 220 patients with premature heart attack (mean age 50, 25% women), almost 70% were classified as low risk by FRS and only 25% met criteria to qualify for medication prior to the heart attack. For women in this population, only 18% met criteria for treatment.20
- People with metabolic syndrome have recently been found to have a 53% higher mortality than is found in people without diabetes or metabolic syndrome. The metabolic syndrome and its components help predict the risk independent of Framingham risk score in people with in diabetics and nondiabetics alike.
- 10-year risk and lifetime risk: A major limitation of FRS is that it estimates the risk of developing CAD within only a 10-yr period. Among young individuals, there is marked disparity between 10-year risk and lifetime risk in the FHS. For example, a 50-year old man in the lowest risk tertile had a 10-year risk of only 4% but a life time risk of 50%. Ford et al have recently estimated that only 3% of the US population would be classified as CAD risk equivalents and therefore qualify for intensive lipid therapy.21 Thus, FRS may not identify subjects with low short-term but high lifetime risk for CAD 22
- These data underscore the need for continued vigilance in those who have been found to be at low short-term risk. Likewise it may underestimate the risk in populations highly prone for premature CAD.
Sources
1. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. Jul 13 2004;110(2):227-239.
2. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. May 12 1998;97(18):1837-1847.
Framingham Risk Score Calculator Pdf To Excel Converter
3. Turnbull F., Pascal Kengne A, MacMahon S. Blood pressure and cardiovascular disease: tracing the steps from Framingham. Prog Cardiovasc Dis. Jul-Aug 2010;53(1):39-44.
4. Moser M. Historical perspectives on the management of hypertension. J Clin Hypertens (Greenwich). Aug 2006;8(8 Suppl 2):15-20; quiz 39.
5. NCEP III. Third Report of the National Cholesterol Education Program(NCEP) Adult Treatment Panel III: National Institute of Health; September2002, 2002. 02-5215.
6. Liu JL, Hong Y, D’Agostino RB, Sr., et al. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. Jama. Jun 2 2004;291(21):2591-2599.
7. Enas EA, Singh V, Munjal YP, et al. Recommendations of the second Indo-U.S. health summit on prevention and control of cardiovascular disease among Asian Indians. Indian Heart J. May-Jun 2009;61(3):265-274.
8. D’Agostino RB Sr, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. Jama. 2001;286(2):180-187.
9. Prediction of mortality from coronary heart disease among diverse populations: is there a common predictive function? Heart. Sep 2002;88(3):222-228.
10. Brindle P, Emberson J, Lampe F, et al. Predictive accuracy of the Framingham coronary risk score in British men: prospective cohort study. Bmj. Nov 29 2003;327(7426):1267.
11. Empana JP, Ducimetiere P, Arveiler D, et al. Are the Framingham and PROCAM coronary heart disease risk functions applicable to different European populations? The PRIME Study. Eur Heart J. Nov 2003;24(21):1903-1911.
12. Marrugat J, D’Agostino R, Sullivan L, et al. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. Aug 2003;57(8):634-638.
13. Menotti A, Puddu PE, Lanti M. Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study. Eur Heart J. Mar 2000;21(5):365-370.
14. Menotti A, Keys A, Kromhout D, et al. Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the seven countries study. Eur J Epidemiol. Sep 1993;9(5):527-536.
15. Wu Y, Liu X, Li X, et al. Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults. Circulation. Nov 21 2006;114(21):2217-2225.
16. Lloyd-Jones DM, Nam BH, D’Agostino RB, Sr., et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults: a prospective study of parents and offspring. Jama. May 12 2004;291(18):2204-2211.
17. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. Nov 2006;49(11):2580-2588.
18. Grundy SM, Pasternak R, Greenland P, Smith S, Jr., Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 1999;100(13):1481-1492.
Framingham Risk Calculator Pda
19. Grundy SM, Balady G, Criqui M, et al. Primary prevention of coronary heart disease: guidance from Framingham: A statement for healthcare professionals from the AHA Task Force on Risk Reduction. American Heart Association. Circulation. 1998;97(18):1876-1887.
20. Akosah KO, Schaper A, Cogbill C, Schoenfeld P. Preventing myocardial infarction in the young adult in the first place: how do the National Cholesterol Education Panel III guidelines perform? J Am Coll Cardiol. May 7 2003;41(9):1475-1479.
Framingham Risk Score Calculator Pdf To Excel Format
21. Ford ES, Giles WH, Mokdad AH. The distribution of 10-Year risk for coronary heart disease among US adults: findings from the National Health and Nutrition Examination Survey III. J Am Coll Cardiol. May 19 2004;43(10):1791-1796.
22. Lloyd-Jones DM, Wilson PW, Larson MG, et al. Framingham risk score and prediction of lifetime risk for coronary heart disease. Am J Cardiol. Jul 1 2004;94(1):20-24.
How does this Framingham risk score calculator work?
This is a health tool designed to estimate heart disease risk in individuals in a period of 10-years, especially that of coronary heart disease, based on a series of factors identified as cardiovascular risk factors in the Framingham Heart Study. It comprises of age, gender and whether the person scored is a smoker or not or under treatment for hypertension; plus three clinical determinations important in assessing cardiovascular function risks: total cholesterol, HDL cholesterol and systolic blood pressure.
The criteria considered in this Framingham risk score calculator is detailed below:
■ Gender - Male/Female, this factor is taken in consideration as the points in the following criteria are segmented by gender.
■ Age – this health calculator permits ages starting from 20 to ensure most individual cases of importance are covered, not only elderly people in which, of course, the heart disease risk is proportional to age.
■ Total cholesterol (mg/dL) – a lower TC than 200 mg/dL is considered low risk while 200 to 239 mg/dL is borderline high and everything above 240 mg/dL is high risk.
■ HDL cholesterol (mg/dL) – contrary to the general belief, not all cholesterol is bad cholesterol. HDL is considered the good one as it consists of high density lipoproteins that don’t stick to the arteries forming plaque and leading to atherosclerosis like LDL. Plus, HDL is also able to remove part of LDL, the bad cholesterol away from the arteries and is said to protect against heart attack and stroke when in levels higher than 60 mg/dL. Everything under 40mg/dL HDL is considered high risk for cardiovascular disease.
■ Under hypertension treatment - Yes/No – people with high blood pressure are at risk of coronary artery disease (atherosclerosis) and hypertension treatment can help lower the risk.
■ Systolic blood pressure (mmHg) - This is the first number in the blood pressure reading with the normal range between 90 and 120 mmHg and corresponds to the force with which the contraction of the heart pushes blood in circulation.
■ Smoker - Yes/No – smoking increases heart disease risk by damaging the arterial lining, leading to atheromas which are buildups narrowing the arteries, leading on the long term to very high risk of angina, heart attack or stroke.
The following tables are presenting the break down of criteria and points in the Framingham scoring model according to gender:
Age | Female pts | Male pts |
20 - 34 | -7 | -9 |
35 - 39 | -3 | -4 |
40 - 44 | 0 | 0 |
45 - 49 | 3 | 3 |
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55 - 59 | 8 | 8 |
60 - 64 | 10 | 10 |
65 - 69 | 12 | 11 |
70 - 74 | 14 | |
>75 | 16 | 13 |
Total cholesterol mg/dL | ||
Value | Female pts | Male pts |
Age interval: 20 - 39 | ||
<160 | 0 | 0 |
160 - 199 | 4 | 4 |
200 - 239 | 8 | 7 |
240 - 279 | 11 | 9 |
>=280 | 13 | 11 |
Age interval: 40 - 49 | ||
<160 | 0 | 0 |
160 - 199 | 3 | 3 |
200 - 239 | 6 | 5 |
240 - 279 | 8 | 6 |
>=280 | 10 | 8 |
Age interval: 50 - 59 | ||
<160 | 0 | 0 |
160 - 199 | 2 | 2 |
200 - 239 | 4 | 3 |
240 - 279 | 5 | 4 |
>=280 | 7 | 5 |
Age interval: 60 - 69 | ||
<160 | 0 | 0 |
160 - 199 | 1 | 1 |
200 - 239 | 2 | 1 |
240 - 279 | 3 | 2 |
>=280 | 4 | 3 |
Age interval: >70 | ||
<160 | 0 | 0 |
160 - 199 | 1 | 0 |
200 - 239 | 1 | 0 |
240 - 279 | 2 | 1 |
>=280 | 2 | 1 |
HDL cholesterol mg/dL | ||
Value | Female pts | Male pts |
>=60 | -1 | -1 |
50 - 59 | 0 | 0 |
40 - 49 | 1 | 1 |
<40 | 2 | 2 |
SBP mmHg / treated | ||
Value | Female pts | Male pts |
<120 | 0 | 0 |
120 - 129 | 3 | 1 |
130 - 139 | 4 | 2 |
140 -159 | 5 | 2 |
>=160 | 6 | 3 |
SBP mmHg / untreated | ||
Value | Female pts | Male pts |
<120 | 0 | 0 |
120 - 129 | 1 | 0 |
130 - 139 | 2 | 1 |
140 -159 | 3 | |
>=160 | 4 | 2 |
Smoking (if yes) | ||
Age | Female pts | Male pts |
20 - 39 | 9 | 8 |
40 - 49 | 7 | 5 |
50 - 59 | 4 | 3 |
60 - 69 | 2 | 1 |
> 70 | 1 | 1 |
Smoking (if no) 0 pts |
Framingham risk score – result interpretation
Female results | Male results | ||
Points | Risk percentage | Points | Risk percentage |
<0 | 0% | <0 | 0% |
0 - 8 | <1% | 0 | <1% |
9 - 12 | 1% | 1 - 4 | 1% |
13 - 14 | 2% | 5 - 6 | 2% |
15 | 3% | 7 | 3% |
16 | 4% | 8 | 4% |
17 | 5% | 9 | 5% |
18 | 6% | 10 | 6% |
19 | 8% | 11 | 8% |
20 | 11% | 12 | 10% |
21 | 14% | 13 | 12% |
22 | 17% | 14 | 16% |
23 | 22% | 15 | 20% |
24 | 27% | 16 | 25% |
>=25 | >30% | >=17 | >30% |
What if the score says I have a high risk of CHD?
The Framingham is a well reputed risk scoring system so these findings should be taken seriously. However, it is important to know that the individual cardiovascular risk is modifiable, meaning it can be decreased through lifestyle changes (quitting smoking, maintaining a healthy diet, exercising regularly) and/ or through preventive treatment (statin, aspirin doses, hypertension medication).
Cardiovascular disease
CVD is a term given to a class of diseases of the heart and blood vessels and includes:
1) Coronary heart disease (CHD)
![Framingham risk score calculator excel Framingham risk score calculator excel](/uploads/1/2/6/3/126304089/646704700.gif)
- Myocardial infarction (MI)
- Heart failure (HF)
- Angina pectoris
- Coronary death
2) Cerebrovascular disease
- Transient ischemic attack (TIA)
- Stroke
3) Aortic disease
- Aortic atherosclerosis
![Risk Risk](/uploads/1/2/6/3/126304089/694725538.png)
- Thoracic aortic aneurysm
- Abdominal aortic aneurysm
4) Peripheral arterial disease
Other risk factors for heart disease
Along with the factors presented in the scoring above there are other lifestyle elements or health conditions deemed to increase heart disease incidence:
- Unhealthy diet
Wargame: european escalation for macro. - Lack of exercise
- Family history
- Diabetes
References
1) D'Agostino RB, Sr. Vasan RS, Pencina M.J, Wolf PA, Cobain M, Massaro JM, Kannel WB. (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117(6): 743–753.
2) Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. (1998) Prediction of coronary heart disease using risk factor categories. Circulation; 97(18):1837-47.
12 Jul, 2015